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Tweet Pearls of the Week 8/31 to 9/7/12

Posted Sep 10 2012 12:00am
Because a good tweet is a terrible thing to waste!

[<a href="" target="_blank">View the story "Tweet Pearls of the Week 8/31 to 9/7" on Storify</a>]<h1>Tweet Pearls of the Week 8/31 to 9/7</h1><h2></h2><p>Storified by Javier Benítez · Sun, Sep 09 2012 09:44:43</p><div>Repeat EKGs if the patient's pain changes or their clinical appearance does not match their initial EKG. You'd be surprised what you'll seeEM Res</div><div>No closed-chest compressions in traumatic arrest and other pearls from @karimbrohi on EMCrit Podcast 81: Weingart</div><div>Urine:NAD.CT head:large dilated ventricles. Normopressure hydrocephalus. Acetozolamide, LPs & neurosurgeons re:shunt? Awesome FY2 diagnosis!ED Doc</div><div>@grahamwalker I'd also add clause saying continue IV therapy past 21hrs until INR<2, APAP<10, AST/ALT down x 2 consec lvls, + Cr at baselineBryan D. Hayes</div><div>@grahamwalker @MDCalc we get 2nd lvl at 8hrs w/ opioid or DPH coingestant. If either above line, start NAC. New UK line should avoid issue.Bryan D. Hayes</div><div>Pearl: When increasing PEEP to meet oxygenation goals, don't forget to check your plateau pressures. Goal plateau pressure is < 30 cm H2O.Critical Care Guys</div><div>QOD: What is the dose of tPA for a patient with a massive pulmonary embolism?Robert R Cooney</div><div>Most references suggest holding heparin during 2hr tPA infusion. MT @EMEducation: aQOD: 100mg over 2hrs. Don't forget to add the heparin.Bryan D. Hayes</div><div>aQOD: 100 mg over 2 hours. Don't forget to add the heparin as well.Robert R Cooney</div><div>Patients allergic to penicillins or cephalosporins can usually tolerate aztreonam, unless the allergy is specifically to ceftazidime.Bryan D. Hayes</div><div>@amalmattu "best lead to look for p waves: V1" #umemgr2012Ari Kestler</div><div>Adenosine for "SVT" is one of those times our ignorance can result in a clean kill. Know when NOT to try it? Hint: Not only adenosine...Jason Cillo</div><div>Answer: Atrial fibrillation with WPW. Use procainamide, ibutilide, propafenone, or flecainide instead. Commonly forgotten by residents, EMS.Jason Cillo</div><div>Q: What are these lines called? Why are they there? #radiology #medstudent #doctor #MedEd Signs</div><div>A: Kerley B lines - almost always due to interstitial oedema WINNERS @DSBryan1 @drmaestro88 @farhanafadzli @jcilloRadiology Signs</div><div>Preview of #ACEP12 @emcrit lecture: cardiac output problem in shock: start by optimizing HR, 80-105 depending on age. Speed vs filling timejeremy faust</div><div>Preview #ACEP12 @emcrit Shock lecture: don't forget that v. high BP can be shock as well. Reminder of classic episode 1 of Emcrit. #scapejeremy faust</div><div>Preview #ACEP12 @emcrit Shock lecture: EGDT basically id'd 5 things which you can optimize to needs: SaO2, preload, afterload, Hb, inotropyjeremy faust</div><div>QOD: What is the treatment for carotid artery dissection and why?Robert R Cooney</div><div>aQOD: Heparin infusion to prevent thrombus formation and subsequent embolization to the cerebral vasculatureRobert R Cooney</div><div>Paeds ED. external jugular access saves the day again. Underused iv access point in sick kids. Towel under back, O2 mask strap to raise veinSimon Carley</div><div>Top EMCast pearl #1: UK stats: CAD is leading cause of death in pregnancy! ACS DOES occur in pregnancy...beware! Mattu</div><div>Top EMCast pearl #2: PPIs are useless, ABX are useful in UGI bleeds. Mattu</div><div>Top EMCast prl#3: H2blockers, HOB elevated, & chlorhexidine po rinses 4 intubated patients will dcreas vent-assoc PNA; Mattu</div><div>@jcillo @jvrbntz @amalmattu In undifferentiated UGIB, PPIs prior to EGD did not reduce mortality/re-bleeding. Give 'em Care Guys</div><div>@amalmattu Even if it IS pericarditis, should you check enzymes to look for associated myocarditis?Jason Cillo</div><div>American Academy of Pediatrics issued a statement in 2003 that syrup of ipecac should no longer be used routinely.Bryan D. Hayes</div><div>Ipecac induces vomiting by local activation of emetic receptors in small intestine and by central stimulation of chemoreceptor trigger zoneBryan D. Hayes</div><div>Mean time to onset of vomiting with ipecac 18.7 minutes, mean number of episodes of vomiting is 3, duration vomiting 23 to 60 minutesBryan D. Hayes</div><div>.@amalmattu Why was I taught to get troponins on people with strokes/TIA? Anyone know?Graham Walker</div><div>@grahamwalker @amalmattu Stroke can cause incr TN, assoc with slightly worse outcome; but no change in tx so I don't thnk u need to send TNsAmal Mattu</div><div>Dr. Rumack's article now in print. Alcoholics tolerate therapeutic doses of acetaminophen up to 4g/day just fine. D. Hayes</div><div>QOD: What condition may account for up to 20% of sudden deaths in patients with structurally normal hearts?Robert R Cooney</div><div>aQOD: Brugada syndromeRobert R Cooney</div><div>10yo triaged w/ "asthma". Tachycardic. Expiratory wheeze. Hb 78. GP treating her for recurrent 'gout'. Here's the CXR. Partyka</div><div>Followup: 10yo w/ "asthma". Expiratory wheeze.Hb 78.Treated for recurrent 'gout'. Now in PICU with CCF & severe MR. Dx: Rheumatic Fever.Chris Partyka</div><div>QoD W/o any neuromuscular dz, how much does succinylcholine typ produces a transient rise in serum K? In pts w/ neuromuscular dz?EMedHome</div><div>AnsQoD W/o neuromuscular dz, succinylcholine typically produces transient K rise of 0.55mEq/L. W/ neuromuscular dz=average incr of 1.8mEq/LEMedHome</div><div>It's time to replace the old P's of MUDPILES (paraldehyde and phenformin) with propylene glycol and propofol (at least in the U.S.)Bryan D. Hayes</div><div>@rollcagemedic The strongest evidence for charcoal is for acetaminophen, aspirin, barbiturates, TCAs, phenytoin, and theophylline.Bryan D. Hayes</div><div>Trip & fall onto flexed knee. Pain ++. Failure of extensor mechanism... what's the Dx ?? Partyka</div><div>@MDaware ... I think an infra-patella problem as the patella is riding a little high. I went with patella tendon.Chris Partyka</div><div>Q: What sign is seen on this mid-lumbar axial T2 weighted image? Diagnosis? #radiology #neurology #MRI #doctors Signs</div><div>A: Empty thecal sac sign of arachnoiditis - cauda equina nerve roots are clumped peripherally WINNER @BasemBahakeemRadiology Signs</div><div>Q: What sign is our handy arrow pointing to on this post contrast CT brain? Diagnosis? #radiology #MedEd #doctors Signs</div><div>Empty delta sign - of dural venous sinus thrombosis within... #radiology #imaging via</div> image source:
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